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Pajula J, Lähteenvuo J, Lähteenvuo M, Honkonen K, Halonen P, Hätinen OP, Kuivanen A, Heikkilä M, Nurro J, Hartikainen J, Ylä-Herttuala S. Adenoviral VEGF-D ΔN ΔC gene therapy for myocardial ischemia. Front Bioeng Biotechnol 2022; 10:999226. [PMID: 36619378 PMCID: PMC9817830 DOI: 10.3389/fbioe.2022.999226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Cardiovascular diseases are the leading cause of death globally. In spite of the availability of improved treatments, there is still a large group of chronic ischemia patients who suffer from significant symptoms and disability. Thus, there is a clear need to develop new treatment strategies for these patients. Therapeutic angiogenesis is a novel therapy method which has shown promising results in preclinical studies. In this study, we evaluated safety and efficacy of adenoviral (Ad) VEGF-DΔNΔC gene transfer for the treatment of myocardial ischemia in a pig model. Methods: Adenoviral VEGF-DΔNΔC gene transfer was given to pigs (n = 26) via intramyocardial injections using an electromechanical injection catheter. Angiogenic effects were evaluated in an acute myocardial infarction model (n = 18) and functionality of the lymphatic vessels were tested in healthy porcine myocardium (n = 8). AdLacZ was used as a control. Results: AdVEGF-DΔNΔC induced safe and effective myocardial angiogenesis by inducing a four-fold increase in mean capillary area at the edge of the myocardial infarct six days after the gene transfer relative to the control AdLacZ group. The effect was sustained over 21 days after the gene transfer, and there were no signs of vessels regression. AdVEGF-DΔNΔC also increased perfusion 3.4-fold near the infarct border zone relative to the control as measured by fluorescent microspheres. Ejection fraction was 8.7% higher in the AdVEGF-DΔNΔC treated group 21 days after the gene transfer relative to the AdLacZ control group. Modified Miles assay detected a transient increase in plasma protein extravasation after the AdVEGF-DΔNΔC treatment and a mild accumulation of pericardial effusate was observed at d6. However, AdVEGF-DΔNΔC also induced the growth of functional lymphatic vasculature, and the amount of pericardial fluid and level of vascular permeability had returned to normal by d21. Conclusion: Endovascular intramyocardial AdVEGF-DΔNΔC gene therapy proved to be safe and effective in the acute porcine myocardial infarction model and provides a new potential treatment option for patients with severe coronary heart disease.
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Affiliation(s)
- Juho Pajula
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | | | - Markku Lähteenvuo
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Krista Honkonen
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Paavo Halonen
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | | | - Antti Kuivanen
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Minja Heikkilä
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Jussi Nurro
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Juha Hartikainen
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland,Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland,Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland,*Correspondence: Seppo Ylä-Herttuala,
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Metsärinne K, Pietilä M, Kantola I, Stenman LK, Hätinen OP, Vesikansa A, Poussa T, Niskanen L. The majority of type 2 diabetic patients in Finnish primary care are at very high risk of cardiovascular events: A cross-sectional chart review study (STONE HF). Prim Care Diabetes 2022; 16:135-141. [PMID: 34972659 DOI: 10.1016/j.pcd.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
AIMS To characterize clinical profiles, prevalence of chronic kidney disease (CKD), and treatment patterns in type 2 diabetes (T2D) and heart failure (HF) patients in Finnish primary care. METHODS A total of 1385 patients (1196 with T2D, 50 with HF, and 139 with T2D and HF) in 60 Finnish primary care centers were recruited to this cross-sectional study. Data on demographic and clinical characteristics, laboratory measurements, and medications were collected retrospectively from medical records. T2D patients were classified according to their risk of cardiovascular (CV) events as very high-risk (62%) and other patients (38%). RESULTS Of the T2D patients, 10% (139/1335) had a diagnosis of HF and 42% (457/1090) had stage 3-5 CKD and/or albuminuria based on laboratory measurement. Of the HF patients, 74% (139/189) had T2D and 78% (114/146) had stage 3-5 CKD and/or albuminuria. Metformin was the most frequently used medication in both very high-risk patients (74%) and other patients (86%). SGLT2 inhibitors and/or GLP-1 analogues were used by 37% of very high-risk patients compared to 42% in other patients. CONCLUSIONS The majority of T2D patients in Finnish primary care are at very high risk of cardiovascular events. However, the implementation of treatments with proven cardioprotective effects in very high-risk patients is currently suboptimal.
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Affiliation(s)
- Kaj Metsärinne
- Turku University Hospital, Department of Nephrology, Turku, Finland.
| | - Mikko Pietilä
- Turku University Hospital, Heart Centre, Turku, Finland
| | - Ilkka Kantola
- Turku University Hospital, Division of Medicine, Turku, Finland
| | | | | | | | | | - Leo Niskanen
- Päijät-Häme Central Hospital, Department of Internal Medicine, Lahti, Finland; University of Eastern Finland, Institute of Clinical Sciences, Kuopio, Finland
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Korpela H, Hätinen OP, Nieminen T, Mallick R, Toivanen P, Airaksinen J, Valli K, Hakulinen M, Poutiainen P, Nurro J, Ylä-Herttuala S. Adenoviral VEGF-B186R127S gene transfer induces angiogenesis and improves perfusion in ischemic heart. iScience 2021; 24:103533. [PMID: 34917905 PMCID: PMC8666349 DOI: 10.1016/j.isci.2021.103533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/29/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022] Open
Abstract
Vascular endothelial growth factor B (VEGF-B) is an interesting therapeutic candidate for coronary artery disease. However, it can also cause ventricular arrhythmias, potentially preventing its use in clinics. We cloned VEGF-B isoforms with different receptor binding profiles to clarify the roles of VEGFR-1 and Nrp-1 in angiogenesis and to see if angiogenic properties can be maintained while avoiding side effects. VEGF-B constructs were studied in vivo using adenovirus (Ad)-mediated intramyocardial gene transfers into the normoxic and ischemic porcine heart (n = 51). It was found that the unprocessed isoform VEGF-B186R127S is as efficient angiogenic growth factor as the native VEGF-B186 in normoxic and ischemic heart. In addition, AdVEGF-B186R127S increased myocardial perfusion reserve by 22% in ischemic heart without any side effects. AdVEGF-B127 (VEGFR-1 and Nrp-1 ligand) and AdVEGF-B109 (VEGFR-1 ligand) did not induce angiogenesis. Thus, VEGF-B186 is angiogenic only before its proteolytic processing to VEGF-B127. Only the VEGF-B186 C-terminal fragment was associated with arrhythmias. AdVEGF-B186R127S induces angiogenesis and improves perfusion in the ischemic heart No significant side effects were observed after AdVEGF-B186R127S therapy VEGF-B186 is angiogenic only prior to its proteolytic processing C-terminal fragment of VEGF-B186 is associated with ventricular arrhythmias
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Affiliation(s)
- Henna Korpela
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli-Pekka Hätinen
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tiina Nieminen
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Kuopio Center for Gene and Cell Therapy, Kuopio, Finland
| | - Rahul Mallick
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Pyry Toivanen
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jonna Airaksinen
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kaisa Valli
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | | | - Jussi Nurro
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I.Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
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Järveläinen N, Halonen P, Nurro J, Hätinen OP, Korpela H, Mäkinen P, Gan LM, Fritsche-Danielson R, Ylä-Herttuala S. Citrate-Saline-Formulated mRNA Delivery into the Heart Muscle with an Electromechanical Mapping and Injection Catheter Does Not Lead to Therapeutic Effects in a Porcine Chronic Myocardial Ischemia Model. Hum Gene Ther 2021; 32:1295-1307. [PMID: 34494459 DOI: 10.1089/hum.2021.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Based on recent success in using modified RNA in clinical applications, we tested the safety, feasibility, and efficacy of direct delivery of citrate-saline-formulated mRNA into an hibernating ischemic heart muscle using an electromechanical mapping and injection catheter system (NOGA/Myostar) in a porcine chronic myocardial ischemia model. Chronic ischemia was induced in domestic pigs (n = 24) using a bottleneck stent placed in the left anterior descending coronary artery. Low (1 mg) and high (7.5 mg) doses of citrate-saline-formulated vascular endothelial growth factor (VEGF)-A165 mRNA were administered in the study. LacZ mRNA and citrate-saline buffer were used as controls. Ten intramyocardial injections (200 μL each) of the mRNAs or citrate-saline buffer were given endovascularly into the hibernating ischemic myocardium using the NOGA catheter. Positron emission tomography 15O-radiowater imaging was performed 7 days after the induction of ischemia and 28 days after the mRNA delivery to measure quantitative myocardial blood perfusion. Coronary angiography, left ventricular function measurements, and clinical chemistry were obtained at each time point. Thirty-five days after the mRNA transfers, pigs were sacrificed, and infarct size and general histology were analyzed. LacZ mRNA pigs were sacrificed 24 h after the transduction. Citrate-saline-formulated mRNA delivery into the ischemic myocardium with endovascular injection catheter did not lead to meaningful transduction with the translation of VEGF-A165, nor therapeutic effects in the heart. VEGF-A165 mRNA showed no statistically significant improvements in left ventricular ejection fraction (LVEF), cardiac output, myocardial perfusion, infarct size, collateral growth, or capillary area in the study groups. However, there was a trend in the high-dose group toward an improved LVEF and cardiac output at rest. No significant adverse effects were observed. In conclusion, the NOGA/Myostar injection catheter system is ineffective in delivering citrate-saline-formulated mRNAs into the heart muscle with the doses and methods used in a porcine chronic myocardial ischemia model.
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Affiliation(s)
- Niko Järveläinen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Paavo Halonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jussi Nurro
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli-Pekka Hätinen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Henna Korpela
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Petri Mäkinen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Li-Ming Gan
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Regina Fritsche-Danielson
- Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
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Säteri T, Nurro J, Hätinen OP, Hakulinen M, Leinonen V, Elomaa AP. 'Ex Vivo Porcine Models Are Valid for Testing and Training Microsurgical Lumbar Decompression Techniques'. World Neurosurg 2021; 155:e64-e74. [PMID: 34380085 DOI: 10.1016/j.wneu.2021.07.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Spinal surgeries are the leading causes for patient settlement issues. Recent European Medical Device Regulations aims to reduce complications by enforcing that surgical tools are validated before clinical use. Human cadavers are favored in preclinical use, but due to anatomical variance, decay and scarce supply, alternative synthetic and animal models are used. This study evaluates the fidelity and validity of porcine models in training and assessment of microsurgical decompressive techniques in lumbar spine. METHODS Anatomical dimensions of ten human and five young pig spines were assessed from CT images. Novel 'en bloc' fresh-frozen ex vivo porcine model tissues' fidelity and validity for decompressive surgery was evaluated by three expert neurosurgeons, in comparison to other models. RESULTS The pig's anatomical dimensions were on average 11% smaller than in humans. The pig's L4-L5 was most alike humans and highest similarity was in lamina and spinous process widths, and skin to posterior longitudinal ligament distance. Dimensional variability was higher in humans (F = 19.06-0.56, p<0.05). The pig's tissues were felt as good as living patients and better than cadavers for skin, fascia, bone, facets, ligamentum flavum and dura, but poor for vessels (experts ICC=0.696-0.903). The pig models validity for assessing drills adverse features (friction, jitter, heating, and soft tissue trauma) were reported unanimously excellent. CONCLUSION Pigs are representative for assessing microsurgical decompression techniques in the lower lumbar spine. The novel 'en bloc' pig model can be an asset for industries and clinicians during assessment and training of new spinal techniques.
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Affiliation(s)
- Tuomas Säteri
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland.
| | - Jussi Nurro
- University of Eastern Finland, AIV Institute, Kuopio, Finland; Saparo Translational Research Oy, Kuopio, Finland
| | | | | | - Ville Leinonen
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland; Kuopio University Hospital, Department of Neurosurgery, Kuopio, Finland
| | - Antti-Pekka Elomaa
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland; Kuopio University Hospital, Department of Neurosurgery, Kuopio, Finland; Kuopio University Hospital, Microsurgery Center www.microsurgerycenter.com, Kuopio, Finland
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Lähteenvuo J, Hätinen OP, Kuivanen A, Huusko J, Paananen J, Lähteenvuo M, Nurro J, Hedman M, Hartikainen J, Laham-Karam N, Mäkinen P, Räsänen M, Alitalo K, Rosenzweig A, Ylä-Herttuala S. Susceptibility to Cardiac Arrhythmias and Sympathetic Nerve Growth in VEGF-B Overexpressing Myocardium. Mol Ther 2020; 28:1731-1740. [PMID: 32243833 DOI: 10.1016/j.ymthe.2020.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/13/2020] [Indexed: 11/18/2022] Open
Abstract
VEGF-B gene therapy is a promising proangiogenic treatment for ischemic heart disease, but, unexpectedly, we found that high doses of VEGF-B promote ventricular arrhythmias (VAs). VEGF-B knockout, alpha myosin heavy-chain promoter (αMHC)-VEGF-B transgenic mice, and pigs transduced intramyocardially with adenoviral (Ad)VEGF- B186 were studied. Immunostaining showed a 2-fold increase in the number of nerves per field (76 vs. 39 in controls, p < 0.001) and an abnormal nerve distribution in the hypertrophic hearts of 11- to 20-month-old αMHC-VEGF-B mice. AdVEGF-B186 gene transfer (GT) led to local sprouting of nerve endings in pig myocardium (141 vs. 78 nerves per field in controls, p < 0.05). During dobutamine stress, 60% of the αMHC-VEGF-B hypertrophic mice had arrhythmias as compared to 7% in controls, and 20% of the AdVEGF-B186-transduced pigs and 100% of the combination of AdVEGF-B186- and AdsVEGFR-1-transduced pigs displayed VAs and even ventricular fibrillation. AdVEGF-B186 GT significantly increased the risk of sudden cardiac death in pigs when compared to any other GT with different VEGFs (hazard ratio, 500.5; 95% confidence interval [CI] 46.4-5,396.7; p < 0.0001). In gene expression analysis, VEGF-B induced the upregulation of Nr4a2, ATF6, and MANF in cardiomyocytes, molecules previously linked to nerve growth and differentiation. Thus, high AdVEGF-B186 overexpression induced nerve growth in the adult heart via a VEGFR-1 signaling-independent mechanism, leading to an increased risk of VA and sudden cardiac death.
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Affiliation(s)
- Johanna Lähteenvuo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Olli-Pekka Hätinen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Antti Kuivanen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Jenni Huusko
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Jussi Paananen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Markku Lähteenvuo
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Jussi Nurro
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Marja Hedman
- Heart Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Nihay Laham-Karam
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Petri Mäkinen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland
| | - Markus Räsänen
- Wihuri Research Institute and Translational Cancer Medicine Program, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Kari Alitalo
- Wihuri Research Institute and Translational Cancer Medicine Program, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | | | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Yliopistonranta 1E, 70211 Kuopio, Finland; Heart Center, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland.
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Pajula JJ, Halonen PJ, Hätinen OP, Ylä-Herttuala S, Nurro J. Adenoviral Gene Transfer of Gremlin Modulates Vascular Endothelial Growth Factor-A-Induced Angiogenesis in Porcine Myocardium. Hum Gene Ther 2020; 31:211-218. [PMID: 31884825 DOI: 10.1089/hum.2019.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Coronary artery disease is a major cause of death and disability worldwide. New therapies are needed for patients who do not benefit or are not suitable for current treatments. Angiogenic gene therapy using vascular endothelial growth factors (VEGFs) has shown potential in preclinical trials. However, undesired side effects, such as increased permeability, limit their therapeutic potential. The aim of this study was to investigate if adenoviral gene transfer of a VEGF receptor 2 (VEGFR-2) ligand Gremlin, given simultaneously with VEGF-A, could modulate VEGFR-2-mediated increase in permeability without impairing the angiogenic effect of VEGF-A gene therapy. Gene transfers were done in pigs (n = 22) using endocardial injections with an endovascular injection catheter. Animals were divided in three groups receiving adenoviral (Ad) VEGF-A (n = 10), Gremlin (n = 6), or VEGF-A+Gremlin (n = 6) gene therapy. Animals were sacrificed and samples collected 6 days later for histological, safety, and permeability analyses. The mean capillary area was significantly increased in both treatment groups with AdVEGF-A when compared with the AdGremlin group. Also, the capillary area was significantly larger in AdVEGF-A group without AdGremlin. No significant differences in tissue permeability were observed using modified Miles assay between AdVEGF-A and AdVEGF-A+AdGremlin groups. However, cardiac tamponade and sudden cardiac deaths were observed only in the AdVEGF-A group. AdVEGF-A induces strong angiogenesis in porcine myocardium. Our results suggest that AdGremlin can limit the side effects of AdVEGF-A therapy, even though no direct effect on tissue permeability could be demonstrated. This could enable the use of larger AdVEGF-A doses to increase the treatment area and angiogenic effects without adverse side effects.
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Affiliation(s)
- Juho J Pajula
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Paavo J Halonen
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | | | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland.,Heart Center and Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland
| | - Jussi Nurro
- A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
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